Stye (Hordeolum) Treatment
The recommended first-line treatment for a stye (hordeolum) is warm compresses applied for 10-15 minutes, 3-4 times daily, combined with eyelid hygiene and gentle massage, followed by topical antibiotics such as erythromycin or bacitracin ointment if signs of infection are present. 1
Treatment Algorithm
First-Line Treatment
- Warm compresses: Apply for 10-15 minutes, 3-4 times daily
- Eyelid hygiene: Clean affected eyelid margins before applying any medication
- Gentle massage: To help promote drainage of the infected gland
Second-Line Treatment
- Topical antibiotics: Apply to the affected eyelid margins when signs of infection are present
- Erythromycin ointment: Apply 1-4 times daily for 7-10 days
- Bacitracin ointment: Apply a small amount 1-3 times daily 2
Third-Line Treatment
- Combination antibiotic/steroid topical treatment: For moderate to severe cases that don't respond to initial therapy
Fourth-Line Treatment
- Intralesional steroid injection or incision and curettage: For persistent (>2 months) or large chalazia 1
Application Technique
- Clean the affected area thoroughly
- Apply a small amount of antibiotic ointment (equivalent to the tip of a finger) to the affected eyelid margin
- May be covered with a sterile bandage if needed 2
Monitoring and Follow-up
- Evaluate for redness, swelling, crusting at lid margins, discharge, and eyelash abnormalities
- Follow-up recommended in 2-4 weeks for moderate cases
- Reassess treatment if no improvement is seen 1
Special Considerations
Common Pitfalls to Avoid
- Inadequate application: Ensure proper application of warm compresses and medications
- Premature discontinuation: Complete the full course of treatment to prevent recurrence
- Overuse of antibiotics: Can lead to antibiotic resistance
- Improper eyelid hygiene: Essential component of treatment that should be performed before applying ointment 1
Prevention of Recurrence
- Regular eyelid hygiene
- Complete removal of eye makeup
- Treatment of underlying conditions (such as blepharitis)
- Discontinuation of contact lens wear until symptoms resolve 1
When to Refer to an Ophthalmologist
- Persistent styes (>2 weeks)
- Styes that develop into chalazia
- Suspected MRSA infections
- Visual changes
- Severe eyelid swelling
- Immunocompromised patients 1
Evidence Quality
The treatment recommendations are primarily based on guidelines from the American Academy of Ophthalmology, which represent the highest level of evidence available 1. It's worth noting that a Cochrane review found no randomized controlled trials specifically evaluating non-surgical interventions for internal hordeola, highlighting a gap in the evidence base 3, 4. Despite this limitation, the consistent expert consensus supports the stepped approach outlined above.